2026 ATI PHARMACOLOGY CMS STUDY GUIDE - RN REVIEW
| LEVEL 2 ATI PREP
1. After giving a PRN opioid, what follow-up is most important? Consider a different clinical setting
(variant 4).
A. Reassess pain, sedation, and respiratory status within the appropriate interval
B. Document only the pain score before administration
C. Wait until the end of the shift to evaluate response
D. Ask the next shift to determine whether the dose worked
Correct Answer: A. Reassess pain, sedation, and respiratory status within the appropriate interval
Rationale: PRN opioids require reassessment of both therapeutic response and respiratory/sedation risk.
2. Which statement best describes how empagliflozin produces its primary pharmacologic effect?
A. inhibits norepinephrine and dopamine reuptake
B. increases urinary glucose excretion
C. replaces elemental iron
D. stimulates pancreatic insulin release
Correct Answer: B. increases urinary glucose excretion
Rationale: empagliflozin works primarily because it increases urinary glucose excretion.
3. A nurse is preparing to administer fluticasone inhaled. Which adverse effect is most important to
recognize?
A. GI upset and QT prolongation
B. oral candidiasis and dysphonia
C. bleeding
D. diarrhea and electrolyte imbalance
Correct Answer: B. oral candidiasis and dysphonia
Rationale: fluticasone inhaled is a inhaled corticosteroid; a key adverse-effect profile includes oral candidiasis
and dysphonia.
4. A client receives a new prescription for hydrochlorothiazide. Which teaching point should the nurse
emphasize?
A. report unusual bleeding
B. report jaundice or dark urine
C. use sun protection and rise slowly
D. avoid grapefruit and maintain dental care
Correct Answer: C. use sun protection and rise slowly
Rationale: The teaching point “use sun protection and rise slowly” directly reduces a recognized safety risk or
improves correct use of hydrochlorothiazide.
5. Which monitoring plan is most appropriate for a client receiving gentamicin?
A. movement symptoms
B. respiratory status and need for repeat dosing
C. renal function and drug levels when indicated
D. renal function, potassium, and CBC when prolonged
Correct Answer: C. renal function and drug levels when indicated
Rationale: Monitoring renal function and drug levels when indicated helps evaluate effectiveness and detect
toxicity or complications from gentamicin.
6. Before giving donepezil, which condition is a major contraindication or high-risk caution?
A. myasthenia gravis
B. significant bradyarrhythmia caution
C. hypersensitivity to product components
D. recurrent severe hypoglycemia
Correct Answer: B. significant bradyarrhythmia caution
Rationale: significant bradyarrhythmia caution is a major contraindication or caution for donepezil.
7. Which monitoring plan is most appropriate for a client receiving alendronate?
A. symptom response and QT risk
,B. thyroid tests and symptoms of infection
C. drug level, renal function, blood pressure
D. renal function and bone health
Correct Answer: D. renal function and bone health
Rationale: Monitoring renal function and bone health helps evaluate effectiveness and detect toxicity or
complications from alendronate.
8. Calculation case 30: A prescription is for 1000 mg. The medication is available as 50 mg per 10 mL. How
many mL should the nurse administer?
A. 200 mL
B. 400 mL
C. 100 mL
D. 210 mL
Correct Answer: A. 200 mL
Rationale: Use desired/available × volume: 1000/50 × 10 = 200 mL.
9. A client receives a new prescription for enoxaparin. Which teaching point should the nurse emphasize?
A. avoid rubbing injection sites
B. therapy is limited by maternal cardiovascular effects
C. report jaundice or dark urine
D. route and indication must be verified
Correct Answer: A. avoid rubbing injection sites
Rationale: The teaching point “avoid rubbing injection sites” directly reduces a recognized safety risk or
improves correct use of enoxaparin.
10. Which client problem is a typical indication for montelukast?
A. GERD and ulcer disease
B. iron-deficiency anemia
C. selected gram-negative infections
D. asthma/allergic rhinitis in selected patients
Correct Answer: D. asthma/allergic rhinitis in selected patients
Rationale: montelukast is used for asthma/allergic rhinitis in selected patients.
11. A client receives a new prescription for glipizide. Which teaching point should the nurse emphasize?
The client is in a different age group and care setting (variant 13).
A. report palpitations or fainting
B. report severe GI symptoms or muscle weakness
C. report unexplained muscle pain
D. do not skip meals after taking it
Correct Answer: D. do not skip meals after taking it
Rationale: The teaching point “do not skip meals after taking it” directly reduces a recognized safety risk or
improves correct use of glipizide.
12. Which statement best describes how vancomycin produces its primary pharmacologic effect?
A. inhibits ADP-mediated platelet activation
B. modulates synaptic vesicle protein SV2A
C. potentiates antithrombin with predominant factor Xa inhibition
D. inhibits bacterial cell-wall synthesis
Correct Answer: D. inhibits bacterial cell-wall synthesis
Rationale: vancomycin works primarily because it inhibits bacterial cell-wall synthesis.
13. Which monitoring plan is most appropriate for a client receiving sertraline?
A. mood, suicidality, and sodium in at-risk patients
B. pulse and respiratory symptoms
C. blood pressure and VTE risk factors
D. liver function when prolonged
Correct Answer: A. mood, suicidality, and sodium in at-risk patients
Rationale: Monitoring mood, suicidality, and sodium in at-risk patients helps evaluate effectiveness and detect
toxicity or complications from sertraline.
,14. A nurse is preparing to administer omeprazole. Which adverse effect is most important to recognize?
A. diarrhea and myopathy/toxicity
B. hypomagnesemia and infection risk with prolonged use
C. hypokalemia, hyponatremia, and hyperuricemia
D. maternal tachycardia and hyperglycemia
Correct Answer: B. hypomagnesemia and infection risk with prolonged use
Rationale: omeprazole is a proton pump inhibitor; a key adverse-effect profile includes hypomagnesemia and
infection risk with prolonged use.
15. Before giving furosemide, which condition is a major contraindication or high-risk caution?
A. severe electrolyte depletion
B. pregnancy and young children when avoidable
C. no absolute contraindication in life-threatening overdose
D. heart block without a pacemaker
Correct Answer: A. severe electrolyte depletion
Rationale: severe electrolyte depletion is a major contraindication or caution for furosemide.
16. Calculation case 15: A prescription is for 125 mg. The medication is available as 125 mg per 2 mL. How
many mL should the nurse administer?
A. 4 mL
B. 1 mL
C. 2 mL
D. Alternative response 3
Correct Answer: C. 2 mL
Rationale: Use desired/available × volume: 125/125 × 2 = 2 mL.
17. Before giving misoprostol, which condition is a major contraindication or high-risk caution?
A. severe hypotension
B. pregnancy when used for ulcer prevention
C. hypersensitivity
D. narrow-angle glaucoma or urinary retention caution
Correct Answer: B. pregnancy when used for ulcer prevention
Rationale: pregnancy when used for ulcer prevention is a major contraindication or caution for misoprostol.
18. Which client problem is a typical indication for fluticasone inhaled? The client is in a different age
group and care setting (variant 7).
A. persistent asthma control
B. selected gram-negative infections
C. susceptible fungal infections
D. COPD maintenance
Correct Answer: A. persistent asthma control
Rationale: fluticasone inhaled is used for persistent asthma control.
19. Which monitoring plan is most appropriate for a client receiving empagliflozin?
A. respiratory rate, reflexes, urine output, serum magnesium when indicated
B. clinical response and renal function
C. renal function, volume status, and glucose
D. blood glucose
Correct Answer: C. renal function, volume status, and glucose
Rationale: Monitoring renal function, volume status, and glucose helps evaluate effectiveness and detect toxicity
or complications from empagliflozin.
20. A nurse is preparing to administer venlafaxine. Which adverse effect is most important to recognize?
A. venous thromboembolism and hypertension
B. nausea, hypertension, and discontinuation symptoms
C. hypertension and thrombosis
D. bradycardia and hypotension
Correct Answer: B. nausea, hypertension, and discontinuation symptoms
Rationale: venlafaxine is a SNRI; a key adverse-effect profile includes nausea, hypertension, and discontinuation
symptoms.
, 21. Before giving ciprofloxacin, which condition is a major contraindication or high-risk caution?
A. situations where vaginal delivery is contraindicated
B. migraine with aura or high VTE risk
C. pregnancy for migraine prevention and major hepatic disease
D. myasthenia gravis
Correct Answer: D. myasthenia gravis
Rationale: myasthenia gravis is a major contraindication or caution for ciprofloxacin.
22. Which client problem is a typical indication for losartan?
A. hypertension
B. prevention/treatment of neutropenia
C. hypothyroidism
D. depression and anxiety disorders
Correct Answer: A. hypertension
Rationale: losartan is used for hypertension.
23. Before giving naloxone, which condition is a major contraindication or high-risk caution?
A. asthma or significant bradycardia
B. dialysis
C. serious structural cardiac disease requires assessment
D. no absolute contraindication in life-threatening overdose
Correct Answer: D. no absolute contraindication in life-threatening overdose
Rationale: no absolute contraindication in life-threatening overdose is a major contraindication or caution for
naloxone.
24. Calculation case 17: A prescription is for 60 mg. The medication is available as 500 mg per 1 mL. How
many mL should the nurse administer?
A. 0.12 mL
B. 0.24 mL
C. 0.06 mL
D. 1.12 mL
Correct Answer: A. 0.12 mL
Rationale: Use desired/available × volume: 60/500 × 1 = 0.12 mL.
25. A nurse is preparing to administer tiotropium. Which adverse effect is most important to recognize?
The client is in a different age group and care setting (variant 13).
A. dry mouth and urinary retention
B. nausea, diarrhea, and bradycardia
C. nephrotoxicity, hypertension, and neurotoxicity
D. bone pain and rare splenic rupture
Correct Answer: A. dry mouth and urinary retention
Rationale: tiotropium is a long-acting muscarinic antagonist; a key adverse-effect profile includes dry mouth and
urinary retention.
26. A client receives a new prescription for insulin glargine. Which teaching point should the nurse
emphasize?
A. take exactly as prescribed
B. report rash, fever, or sore throat
C. do not mix in the same syringe with other insulins unless product guidance permits
D. report flushing during infusion
Correct Answer: C. do not mix in the same syringe with other insulins unless product guidance permits
Rationale: The teaching point “do not mix in the same syringe with other insulins unless product guidance
permits” directly reduces a recognized safety risk or improves correct use of insulin glargine.
27. Before giving valproate, which condition is a major contraindication or high-risk caution?
A. severe renal/hepatic impairment with strong CYP3A4/P-gp inhibitors
B. dose adjustment in renal impairment
C. serious penicillin allergy
D. pregnancy for migraine prevention and major hepatic disease
Correct Answer: D. pregnancy for migraine prevention and major hepatic disease
| LEVEL 2 ATI PREP
1. After giving a PRN opioid, what follow-up is most important? Consider a different clinical setting
(variant 4).
A. Reassess pain, sedation, and respiratory status within the appropriate interval
B. Document only the pain score before administration
C. Wait until the end of the shift to evaluate response
D. Ask the next shift to determine whether the dose worked
Correct Answer: A. Reassess pain, sedation, and respiratory status within the appropriate interval
Rationale: PRN opioids require reassessment of both therapeutic response and respiratory/sedation risk.
2. Which statement best describes how empagliflozin produces its primary pharmacologic effect?
A. inhibits norepinephrine and dopamine reuptake
B. increases urinary glucose excretion
C. replaces elemental iron
D. stimulates pancreatic insulin release
Correct Answer: B. increases urinary glucose excretion
Rationale: empagliflozin works primarily because it increases urinary glucose excretion.
3. A nurse is preparing to administer fluticasone inhaled. Which adverse effect is most important to
recognize?
A. GI upset and QT prolongation
B. oral candidiasis and dysphonia
C. bleeding
D. diarrhea and electrolyte imbalance
Correct Answer: B. oral candidiasis and dysphonia
Rationale: fluticasone inhaled is a inhaled corticosteroid; a key adverse-effect profile includes oral candidiasis
and dysphonia.
4. A client receives a new prescription for hydrochlorothiazide. Which teaching point should the nurse
emphasize?
A. report unusual bleeding
B. report jaundice or dark urine
C. use sun protection and rise slowly
D. avoid grapefruit and maintain dental care
Correct Answer: C. use sun protection and rise slowly
Rationale: The teaching point “use sun protection and rise slowly” directly reduces a recognized safety risk or
improves correct use of hydrochlorothiazide.
5. Which monitoring plan is most appropriate for a client receiving gentamicin?
A. movement symptoms
B. respiratory status and need for repeat dosing
C. renal function and drug levels when indicated
D. renal function, potassium, and CBC when prolonged
Correct Answer: C. renal function and drug levels when indicated
Rationale: Monitoring renal function and drug levels when indicated helps evaluate effectiveness and detect
toxicity or complications from gentamicin.
6. Before giving donepezil, which condition is a major contraindication or high-risk caution?
A. myasthenia gravis
B. significant bradyarrhythmia caution
C. hypersensitivity to product components
D. recurrent severe hypoglycemia
Correct Answer: B. significant bradyarrhythmia caution
Rationale: significant bradyarrhythmia caution is a major contraindication or caution for donepezil.
7. Which monitoring plan is most appropriate for a client receiving alendronate?
A. symptom response and QT risk
,B. thyroid tests and symptoms of infection
C. drug level, renal function, blood pressure
D. renal function and bone health
Correct Answer: D. renal function and bone health
Rationale: Monitoring renal function and bone health helps evaluate effectiveness and detect toxicity or
complications from alendronate.
8. Calculation case 30: A prescription is for 1000 mg. The medication is available as 50 mg per 10 mL. How
many mL should the nurse administer?
A. 200 mL
B. 400 mL
C. 100 mL
D. 210 mL
Correct Answer: A. 200 mL
Rationale: Use desired/available × volume: 1000/50 × 10 = 200 mL.
9. A client receives a new prescription for enoxaparin. Which teaching point should the nurse emphasize?
A. avoid rubbing injection sites
B. therapy is limited by maternal cardiovascular effects
C. report jaundice or dark urine
D. route and indication must be verified
Correct Answer: A. avoid rubbing injection sites
Rationale: The teaching point “avoid rubbing injection sites” directly reduces a recognized safety risk or
improves correct use of enoxaparin.
10. Which client problem is a typical indication for montelukast?
A. GERD and ulcer disease
B. iron-deficiency anemia
C. selected gram-negative infections
D. asthma/allergic rhinitis in selected patients
Correct Answer: D. asthma/allergic rhinitis in selected patients
Rationale: montelukast is used for asthma/allergic rhinitis in selected patients.
11. A client receives a new prescription for glipizide. Which teaching point should the nurse emphasize?
The client is in a different age group and care setting (variant 13).
A. report palpitations or fainting
B. report severe GI symptoms or muscle weakness
C. report unexplained muscle pain
D. do not skip meals after taking it
Correct Answer: D. do not skip meals after taking it
Rationale: The teaching point “do not skip meals after taking it” directly reduces a recognized safety risk or
improves correct use of glipizide.
12. Which statement best describes how vancomycin produces its primary pharmacologic effect?
A. inhibits ADP-mediated platelet activation
B. modulates synaptic vesicle protein SV2A
C. potentiates antithrombin with predominant factor Xa inhibition
D. inhibits bacterial cell-wall synthesis
Correct Answer: D. inhibits bacterial cell-wall synthesis
Rationale: vancomycin works primarily because it inhibits bacterial cell-wall synthesis.
13. Which monitoring plan is most appropriate for a client receiving sertraline?
A. mood, suicidality, and sodium in at-risk patients
B. pulse and respiratory symptoms
C. blood pressure and VTE risk factors
D. liver function when prolonged
Correct Answer: A. mood, suicidality, and sodium in at-risk patients
Rationale: Monitoring mood, suicidality, and sodium in at-risk patients helps evaluate effectiveness and detect
toxicity or complications from sertraline.
,14. A nurse is preparing to administer omeprazole. Which adverse effect is most important to recognize?
A. diarrhea and myopathy/toxicity
B. hypomagnesemia and infection risk with prolonged use
C. hypokalemia, hyponatremia, and hyperuricemia
D. maternal tachycardia and hyperglycemia
Correct Answer: B. hypomagnesemia and infection risk with prolonged use
Rationale: omeprazole is a proton pump inhibitor; a key adverse-effect profile includes hypomagnesemia and
infection risk with prolonged use.
15. Before giving furosemide, which condition is a major contraindication or high-risk caution?
A. severe electrolyte depletion
B. pregnancy and young children when avoidable
C. no absolute contraindication in life-threatening overdose
D. heart block without a pacemaker
Correct Answer: A. severe electrolyte depletion
Rationale: severe electrolyte depletion is a major contraindication or caution for furosemide.
16. Calculation case 15: A prescription is for 125 mg. The medication is available as 125 mg per 2 mL. How
many mL should the nurse administer?
A. 4 mL
B. 1 mL
C. 2 mL
D. Alternative response 3
Correct Answer: C. 2 mL
Rationale: Use desired/available × volume: 125/125 × 2 = 2 mL.
17. Before giving misoprostol, which condition is a major contraindication or high-risk caution?
A. severe hypotension
B. pregnancy when used for ulcer prevention
C. hypersensitivity
D. narrow-angle glaucoma or urinary retention caution
Correct Answer: B. pregnancy when used for ulcer prevention
Rationale: pregnancy when used for ulcer prevention is a major contraindication or caution for misoprostol.
18. Which client problem is a typical indication for fluticasone inhaled? The client is in a different age
group and care setting (variant 7).
A. persistent asthma control
B. selected gram-negative infections
C. susceptible fungal infections
D. COPD maintenance
Correct Answer: A. persistent asthma control
Rationale: fluticasone inhaled is used for persistent asthma control.
19. Which monitoring plan is most appropriate for a client receiving empagliflozin?
A. respiratory rate, reflexes, urine output, serum magnesium when indicated
B. clinical response and renal function
C. renal function, volume status, and glucose
D. blood glucose
Correct Answer: C. renal function, volume status, and glucose
Rationale: Monitoring renal function, volume status, and glucose helps evaluate effectiveness and detect toxicity
or complications from empagliflozin.
20. A nurse is preparing to administer venlafaxine. Which adverse effect is most important to recognize?
A. venous thromboembolism and hypertension
B. nausea, hypertension, and discontinuation symptoms
C. hypertension and thrombosis
D. bradycardia and hypotension
Correct Answer: B. nausea, hypertension, and discontinuation symptoms
Rationale: venlafaxine is a SNRI; a key adverse-effect profile includes nausea, hypertension, and discontinuation
symptoms.
, 21. Before giving ciprofloxacin, which condition is a major contraindication or high-risk caution?
A. situations where vaginal delivery is contraindicated
B. migraine with aura or high VTE risk
C. pregnancy for migraine prevention and major hepatic disease
D. myasthenia gravis
Correct Answer: D. myasthenia gravis
Rationale: myasthenia gravis is a major contraindication or caution for ciprofloxacin.
22. Which client problem is a typical indication for losartan?
A. hypertension
B. prevention/treatment of neutropenia
C. hypothyroidism
D. depression and anxiety disorders
Correct Answer: A. hypertension
Rationale: losartan is used for hypertension.
23. Before giving naloxone, which condition is a major contraindication or high-risk caution?
A. asthma or significant bradycardia
B. dialysis
C. serious structural cardiac disease requires assessment
D. no absolute contraindication in life-threatening overdose
Correct Answer: D. no absolute contraindication in life-threatening overdose
Rationale: no absolute contraindication in life-threatening overdose is a major contraindication or caution for
naloxone.
24. Calculation case 17: A prescription is for 60 mg. The medication is available as 500 mg per 1 mL. How
many mL should the nurse administer?
A. 0.12 mL
B. 0.24 mL
C. 0.06 mL
D. 1.12 mL
Correct Answer: A. 0.12 mL
Rationale: Use desired/available × volume: 60/500 × 1 = 0.12 mL.
25. A nurse is preparing to administer tiotropium. Which adverse effect is most important to recognize?
The client is in a different age group and care setting (variant 13).
A. dry mouth and urinary retention
B. nausea, diarrhea, and bradycardia
C. nephrotoxicity, hypertension, and neurotoxicity
D. bone pain and rare splenic rupture
Correct Answer: A. dry mouth and urinary retention
Rationale: tiotropium is a long-acting muscarinic antagonist; a key adverse-effect profile includes dry mouth and
urinary retention.
26. A client receives a new prescription for insulin glargine. Which teaching point should the nurse
emphasize?
A. take exactly as prescribed
B. report rash, fever, or sore throat
C. do not mix in the same syringe with other insulins unless product guidance permits
D. report flushing during infusion
Correct Answer: C. do not mix in the same syringe with other insulins unless product guidance permits
Rationale: The teaching point “do not mix in the same syringe with other insulins unless product guidance
permits” directly reduces a recognized safety risk or improves correct use of insulin glargine.
27. Before giving valproate, which condition is a major contraindication or high-risk caution?
A. severe renal/hepatic impairment with strong CYP3A4/P-gp inhibitors
B. dose adjustment in renal impairment
C. serious penicillin allergy
D. pregnancy for migraine prevention and major hepatic disease
Correct Answer: D. pregnancy for migraine prevention and major hepatic disease
